Behavioral Surveillance Survey Research Articles

HIV epidemic among men who have sex with men in India: national scenario of an unfinished agenda.

BackgroundAlthough India has demonstrated success in the overall reduction of human immunodeficiency virus (HIV) incidence by 57% in the past 10 years, its control among men who have sex with men (MSM) remains a critical challenge. This paper describes the current status, geographic variability, and factors associated with HIV among MSM from the national perspective.MethodsData on the levels and trends of HIV seropositivity and associated risk behaviors among MSM were analyzed and presented from the following data sources: 1) annual HIV Sentinel Surveillance (HSS) conducted during 2003–10, 2) two rounds of the high-risk group size estimation conducted in 2005 and 2009, 3) two rounds of the Behavioral Surveillance Survey conducted in 2006 and 2009, and 4) the Integrated Bio-behavioral Assessment Round 2. Data were analyzed according to selected sociodemographic characteristics and sexual identities of MSM to understand the factors associated with high HIV prevalence.ResultsHSS data indicate that at the national level, HIV prevalence among MSM overall is declining (from 12.3% in 2003 to 4.43% in 2010). However, marginal increasing trends were observed in Chandigarh (from 1.4% in 2004 to 2.8% in 2008) and Haryana (from 0% in 2006 to 3.2% in 2008). HSS data indicate high (>5%) levels and increasing trends in HIV prevalence among MSM in eight states of India during 2003–10. Analysis of 2010 HSS data indicates that HIV prevalence was >10% in seven states. The factors associated with high HIV prevalence among MSM were being a kothi (the receptive partner in oral and anal sex, and typically with effeminate mannerisms) or a double-decker (both penetrative and receptive partner) rather than being a panthi (the penetrative partner in oral or anal sex) (8% vs 4.3%; P<0.05), being older than 25 years in age than their younger counterparts (9% vs 4.5%; P<0.05), illiterate rather than literate MSM (9.5% vs 6.9%; P<0.05), and employed versus unemployed MSM (9.1% vs 7.8%; P<0.05).ConclusionWhile HIV prevalence among MSM at the national level is declining, it continues to remain high in some states and cities. Programs need to build on the successes in reducing HIV among female sex workers in order to control the high HIV prevalence among MSM in India.

Sexual and reproductive health for young adults in Colombia: teleconsultation using mobile devices.

BackgroundSexual risk behaviors associated with poor information on sexuality have contributed to major public health problems in the area of sexual and reproductive health in teenagers and young adults in Colombia.ObjectiveTo report our experience with the use of DoctorChat Mobile to provide sexual education and information among university students in Bogota, Colombia, and knowledge about the sexual risk factors detected among them.MethodsA mobile app that allows patients to ask about sexual and reproductive health issues was developed. Sexual and reproductive risk behaviors in a sample of young adults were measured before and after the use of the app through the validated survey Family Health International (FHI) Behavioral Surveillance Survey (BSS) for Use With Adults Between 15 and 49 Years. A nonprobabilistic convenience recruitment was undertaken through the study´s webpage. After completing the first survey, participants were allowed to download and use the app for a 6-month period (intervention), followed by completion of the same survey once again. For the inferential analysis, data was divided into 3 groups (dichotomous data, discrete quantitative data, and ordinal data) to compare the results of the questions between the first and the second survey. The study was carried out with a sample of university students between 18 and 29 years with access to mobile phones. Participation in the study was voluntary and anonymous.ResultsA total of 257 subjects met the selection criteria. The preintervention survey was answered by 232 subjects, and 127 of them fully answered the postintervention survey. In total, 54.3% (69/127) of the subjects completed the survey but did not use the app, leaving an effective population of 58 subjects for analysis. Of these subjects, 53% (31/58) were women and 47% (27/58) were men. The mean age was 21 years, ranging between 18 and 29 years. The differences between the answers from both surveys were not statistically significant. The main sexual risk behaviors identified in the population were homosexual intercourse, nonuse of condoms, sexual intercourse with nonregular and commercial partners, the use of psychoactive substances, and lack of knowledge on symptoms of sexually transmitted diseases and HIV transmission.ConclusionsAlthough there were no differences between the pre- and postintervention results, the study revealed different risk behaviors among the participating subjects. These findings highlight the importance of promoting high-impact educational strategies on this matter and the importance of providing teenagers and young adults with easily accessible tools with reliable health information, regardless of their socioeconomic status.

Assessing differences in groups randomized by recruitment chain in a respondent-driven sample of Seattle-area injection drug users

PurposeRespondent-driven sampling (RDS) is a form of peer-based study recruitment and analysis that incorporates features designed to limit and adjust for biases in traditional snowball sampling. It is being widely used in studies of hidden populations. We report an empirical evaluation of RDS's consistency and variability, comparing groups recruited contemporaneously, by identical methods and using identical survey instruments. MethodsWe randomized recruitment chains from the RDS-based 2012 National HIV Behavioral Surveillance survey of injection drug users in the Seattle area into two groups and compared them in terms of sociodemographic characteristics, drug-associated risk behaviors, sexual risk behaviors, human immunodeficiency virus (HIV) status and HIV testing frequency. ResultsThe two groups differed in five of the 18 variables examined (P ≤ .001): race (e.g., 60% white vs. 47%), gender (52% male vs. 67%), area of residence (32% downtown Seattle vs. 44%), an HIV test in the previous 12 months (51% vs. 38%). The difference in serologic HIV status was particularly pronounced (4% positive vs. 18%). In four further randomizations, differences in one to five variables attained this level of significance, although the specific variables involved differed. ConclusionsWe found some material differences between the randomized groups. Although the variability of the present study was less than has been reported in serial RDS surveys, these findings indicate caution in the interpretation of RDS results.

Optimizing the implementation of integrated biological and behavioural surveillance surveys of HIV in resource limited settings-lessons from Nepal

ObjectiveTo discuss the basic standards for HIV related integrated biological and behavioural surveillance (IBBS) survey implementation, specific challenges of survey management, and to propose brief practical guidelines for management of IBBS surveys in resource limited setting. MethodsTwo methods were used to address our study objectives: (a) a narrative review of the literature and (b) our experience as participant observer when working on IBBS survey management between July 2012 and January 2013 in Nepal. ResultsIn Nepal, IBBS surveys are conducted among key populations at higher risk of HIV such as people who inject drugs, men who have sex with men, female sex workers, seasonal male labour migrants and truckers (proxy for clients of female sex workers). The involvement of different institutions, people, and procedures makes IBBS survey management-including planning, implementation, sharing of findings and possible uses of survey findings-complicated to perform. In addition, basic survey methods and techniques including respondent driven sampling and two stage cluster sampling, are sometimes not properly performed in practice. ConclusionsThis study showed that field implementation of some standards methods such as respondent driven sampling and cluster sampling for HIV related estimate or trends used for IBBS survey could be improved. This paper described lessons learnt and may be used as a guiding reference to improve and evaluate IBBS surveys in resource-poor settings also outside of Nepal.

Population size, HIV, and behavior among MSM in Luanda, Angola: challenges and findings in the first ever HIV and syphilis biological and behavioral survey.

To conduct the first population size estimation and biological and behavioral surveillance survey among men who have sex with men (MSM) in Angola. Population size estimation with multiplier method and a cross-sectional study using respondent-driven sampling. Luanda Province, Angola. Study was conducted in a large hospital. Seven hundred ninety-two self-identified MSM accepted a unique object for population size estimation. Three hundred fifty-one MSM were recruited with respondent-driven sampling for biological and behavioral surveillance survey. Interviews and testing for HIV and syphilis were conducted on-site. Analysis used Respondent-Driven Sampling Analysis Tool and STATA 11.0. Univariate, bivariate, and multivariate analyses examined factors associated with HIV and unprotected sex. Six imputation strategies were used for missing data for those refusing to test for HIV. A population size of 6236 MSM was estimated. Twenty-seven of 351 individuals were tested positive. Adjusted HIV prevalence was 3.7% (8.7% crude). With imputation, HIV seroprevalence was estimated between 3.8% [95% confidence interval (CI): 1.6 to 6.5] and 10.5% (95% CI: 5.6 to 15.3). Being older than 25 (odds ratio = 10.8, 95% CI: 3.5 to 32.8) and having suffered episodes of homophobia (odds ratio = 12.7, 95% CI: 3.2 to 49.6) significantly increased the chance of HIV seropositivity. Risk behaviors are widely reported, but HIV seroprevalence is lower than expected. The difference between crude and adjusted values was mostly due to treatment of missing values in Respondent-Driven Sampling Analysis Tool. Solutions are proposed in this article. Although concerns were raised about feasibility and adverse outcomes for MSM, the study was successfully and rapidly completed with no adverse effects.

Risky behavior and correlates of HIV and Hepatitis C Virus infection among people who inject drugs in three cities in Afghanistan

BackgroundInjecting drug use is the primary mode of HIV transmission and acquisition in Afghanistan. People who inject drugs (PWID) in the country have been characterized by high risk injecting behavior and a high burden of HCV infection. We aimed to estimate the burden of HIV, HCV, and other infectious diseases and to identify the correlates of HIV and HCV infection among PWID living in three major Afghan cities in 2009. MethodsEpidemiologic data was collected among PWID for the integrated biological and behavioral surveillance (IBBS) survey between May and August, 2009 in three Afghan cities. Data were collected using a structured questionnaire and biologic specimens to screen for HIV, HBV, HCV, syphilis, and HSV-2 using rapid testing kits. Multiple logistic regression models were constructed to identify correlates of infection. ResultsAmong 548 participants, pooled HIV prevalence was 7.1% (Mazar-i-Sharif: 1.0%, Kabul: 3.1%, Herat: 18.4%) and HCV prevalence was 40.3%. Almost all participants with HIV infection were co-infected with HCV (94.9%). Pooled prevalence estimates for other diseases included 7.1% for HBV, 5.5% for syphilis; and 9.3% for HSV-2. Living in Herat, ever in prison and time injecting were independently associated with HIV infection. Living in Kabul, Herat and time injecting were independently associated with HCV infection. ConclusionsThere is a high and heterogeneous burden of HIV and HCV among PWID in Afghan cities. Provision of comprehensive harm reduction services to PWID in Afghanistan is warranted to reduce exposures associated with HIV and HCV infection, especially in the city of Herat.

Epidemiology of HIV and AIDS among adolescents: current status, inequities, and data gaps.

To examine levels and patterns of HIV prevalence, knowledge, sexual behavior, and coverage of selected HIV services among adolescents aged 10-19 years and highlight data gaps and challenges. Data were reviewed from Joint United Nations Programme on HIV/AIDS HIV estimates, nationally representative household surveys, behavioral surveillance surveys, and published literature. A number of gaps exist for adolescent-specific HIV-related data; however, important implications for programming can be drawn. Eighty-two percent of the estimated 2.1 million adolescents aged 10-19 years living with HIV in 2012 were in sub-Saharan Africa, and the majority of these (58%) were females. Comprehensive accurate knowledge about HIV, condom use, HIV testing, and antiretroviral treatment coverage remain low in most countries. Early sexual debut (sex before 15 years of age) is more common among adolescent girls than boys in low- and middle-income countries, consistent with early marriage and early childbirth in these countries. In low and concentrated epidemic countries, HIV prevalence is highest among key populations. Although the available HIV-related data on adolescents are limited, increased HIV vulnerability in the second decade of life is evident in the data. Improving data gathering, analysis, and reporting systems specific to adolescents is essential to monitoring progress and improving health outcomes for adolescents. More systematic and better quality disaggregated data are needed to understand differences by sex, age, geography, and socioeconomic factors and to address equity and human rights obligations, especially for key populations.

The cumulative impact of physical activity, sleep duration, and television time on adolescent obesity: 2011 Youth Risk Behavior Survey.

Physical activity (PA), television time (TV), and sleep duration (SLP) are considered individual risk factors for adolescent obesity. Our aim was to investigate the concurrent influence of meeting PA, SLP, and TV recommendations on adolescent obesity utilizing 2011 Youth Risk Behavior Surveillance Survey (YRBSS) data. Subjects included 9589 (4874 females) high school students. PA, SLP, and TV were categorized utilizing established national recommendations and youth were cross-tabulated into 1 of 8 groups based on meeting or not meeting each recommendation. Logistic models were used to examine the odds of obesity for each group. Youth meeting the PA recommendation were not at increased odds of obesity, regardless of SLP or TV status. However, not meeting any single recommendation, in general, led to increased odds of not meeting the other two. In boys, 11.8% met all recommendations while 14.1% met 0 recommendations. In girls, only 5.0% met all recommendations while 17.8% met none. Boys and girls not meeting any of the recommendations were 4.0 and 3.8 times more likely to be obese compared with their respective referent groups. Further research considering the simultaneous influence these risk factors may have on obesity and on one another is warranted.

HIV prevalence and risk behaviours among foreign migrant women residing in Cape Town, South Africa.

HIV prevalence and risk behaviour among foreign migrants in South Africa has not been explored. This paper describes the effectiveness of respondent-driven sampling (RDS) to recruit foreign migrant women residing in Cape Town, reports HIV prevalence, and describes key characteristics among them. We conducted a biological and behavioural surveillance survey using RDS. After written informed consent, participants completed an audio computer assisted self-interview and provided a dried blood sample for HIV analysis. HIV prevalence was estimated to be 7 % (CI 4.9-9.5) among 935 women. HIV sero-positivity was associated with older age (p = 0.001), country of origin (p < 0.000), being unmarried (p < 0.000), having lived in South Africa for 3-5 years (p = 0.023), sexual debut at ≥15 years (p = 0.047), and having used a condom at last sex with a main partner (p = 0.007). Few women reported early sexual debut, or multiple sexual partners. RDS was successful in recruiting foreign migrant women.

HIV-related behavioral risk factors among older female sex workers in Guangxi, China

Previous literature suggests a high rate of HIV infections among older female sex workers (FSWs) in China. However, limited data are available regarding HIV- related behavioral risk factors among this population. In the current study, we aim to examine the demographic and behavioral factors that place older FSWs at a high risk of HIV infection. We conducted secondary analysis of the 2010 National Sentinel Surveillance (NSS) data from Guangxi, China. A self-administered, standard behavioral surveillance survey was completed by a total of 12,622 FSWs in Guangxi, China. The Guangxi 2010 NSS sample included 19.4% FSWs aged 35 years or older (“older FSWs”). The overall HIV prevalence was 1.0% for the entire sample with 2.0% among older FSWs and 0.8% among younger ones. Older age was an independent predictor of unprotected sex, injection drug use, and a self-reported history of syphilis infection. Future HIV prevention interventions targeting FSWs should consider older FSWs' vulnerable status. Efforts are needed to address their financial needs and invest in skills for socio-economic empowerment.

Evidence for risk reduction among amphetamine-injecting men who have sex with men; results from national HIV behavioral surveillance surveys in the Seattle area 2008-2012.

In the Seattle area men who have sex with men and also inject amphetamines (amphetamine-injecting MSM/IDU) are disproportionately likely to be infected with HIV. To characterize their distinctive characteristics, we combined data from two Seattle-area surveys of men who have sex with men (MSM) and two surveys of injection drug users (IDU). Amphetamine-injecting MSM/IDU were compared with: male IDU, MSM and other MSM/IDU. Amphetamine-injecting MSM/IDU were older than MSM but younger than IDU, more likely to be white than either group, and had an educational level higher than IDU but below MSM. They had the highest HIV prevalence (56 vs. 4-19 %). However, reported HIV cases among them fell from 92 in 1990 to 25 in 2012. They were most likely to report ten or more sex partners (49 vs. 4-26 %), an STD diagnosis (22 vs. 1-7 %) and be tested for HIV (odds ratio 1.00 vs. 0.34-0.52), and least likely to share needles (odds ratio 1.00 vs. 6.80-10.50). While sexual risk remains high, these data suggest measurable and effective risk reduction with respect to sharing injection equipment and HIV testing among Seattle-area amphetamine-injecting MSM/IDU.

Adolescent risk-taking and resting state functional connectivity

The existing literature on the role of emotion regulation circuits (amygdala-prefrontal cortex) in the adolescent brain yields mixed results, particularly on the role of these regions in the context of reward sensitivity and risk-taking behavior sensitivity and risk-taking behavior. Here, we examined functional connectivity in the resting state in 18 risk-taking (RT) adolescents compared with 18 non-risk-taking (NRT) adolescents as defined by the Youth Risk Behavior Surveillance Survey. Separate seed-based correlations with bilateral amygdala and bilateral nucleus accumbens used as the seed were performed to determine functional connectivity using functional magnetic resonance imaging (fMRI). The results showed greater connectivity between the amygdala (seed region) and the right middle frontal gyrus, left cingulate gyrus, left precuneus and right inferior parietal lobule in RT adolescents than in NRT adolescents. Likewise, there was greater connectivity between the nucleus accumbens (seed region) and the right middle frontal gyrus in RT adolescents compared with NRT adolescents. These findings suggest that risk-taking behavior in adolescents is associated with hyperconnectivity during the resting state in networks associated with emotion regulation, reward sensitivity, executive control, and the default mode.

High-risk sex and displacement among refugees and surrounding populations in 10 countries

Between 2004 and 2012, the United Nations High Commissioner for Refugees conducted behavioural surveillance surveys in 27 separate communities in 10 countries. Random systematic or two-stage cluster sampling was used among participants of age 15-49 years, using a modified standard questionnaire. We conducted descriptive data analysis and multivariable logistic regression to identify factors independently associated with multiple sexual partnerships. Of 27 sites surveyed comprising 24 219 individuals, 11 refugee and surrounding communities were paired. Recent displacement comprised less than 10% of participants. Visiting neighbouring communities varied from 8.6 to 74.4%. Multiple sexual partnerships varied from 2.7% in Sudan to 32.5% in Tanzania. Condom use during last sex was low in most of the communities (<5%). The prevalence of forced sex was similar in paired sites, with intimate partner violence being the most frequent, ranging between 1.0 and 4.6% in camps and 0.8 and 3.6% in communities, with the exception of Nepal (10.8 and 9.8%). Being away from home for more than 1 month and having lived in community for less than 12 months was associated with multiple partnerships in six and five of 16 sites, respectively. In the largest study of paired sites of refugees in protracted refugee camps and surrounding nationals, data showed no consistent difference in levels of risky sexual behaviour and there was much variation among the different groups. The prevention strategies should be targeted in a highly integrated manner for both the communities. Forced sex among women was reported at similar levels among refugees and nationals, with intimate partner violence being the most common. These findings should reduce stigma and discrimination against refugees.

Cannabis use among young people in Pacific Island Countries and Territories

Since the 2011 report by Howard, Ali and Roberts2 on alcohol, cannabis and amphetamine use among young people in the Western Pacific Region (WPR), more recent data has become available, allowing a clearer picture of cannabis use in the region’s Pacific Island Countries and Territories (PICTs). Surveys in the WPR have primarily used three standardised instruments: the youth risk behaviour survey (YRBS);3 WHO’s global school-based student health survey (GSHS);4 and the second generation behaviour surveillance survey (BSS)5. Data on cannabis use was extracted from these three surveys from the PICTs. Data from Australia and New Zealand – where secondary school surveys (SSS) are used6,7 – and the United States was also extracted for comparison.

African-American Adolescent Females in the Southeastern United States: Associations Among Risk Factors for Teen Pregnancy

This study examined the associations among three external variables (Peer Substance Use Before Sex, Peer Number of Children, and Parental Influence and Substance Use Before Sex and History of Pregnancy) identified on the Youth Risk Behavior Surveillance Survey and a demographic survey, using Bandura's Social Learning Theory as an interpretive model for understanding these relationships. Participants were 276 African-American females, ages 13 to 18 years, enrolled in two public schools in the Mississippi Delta, with 14% of the sample reporting they had been pregnant. Analysis of variance found that teens with a history of pregnancy were significantly more likely to have a greater number of lifetime sexual partners. Teenagers with a history of pregnancy also were significantly more likely to report peer alcohol use before sex and peer history of pregnancy. Furthermore, their parents had diminished expectancies regarding teenage pregnancy.

Relationship of Media Location to Adolescent Health-risk Behaviors: Gender Differences

The aim was to explore relationships among the risk factor of peer influence, the protective resource of parental monitoring, location of media use, and the outcomes of health-risk behaviors (smoking cigarettes, smoking marijuana, drinking alcohol, age at first coitus, number of sex partners, contraceptive use, and use of alcohol or drugs with sex), and to further explore differences between females and males. This analysis is one component of a longitudinal study of health-risk behaviors in high school-aged adolescents. Following IRB approval and written informed consent of the participants, data were collected either by computer or by mailed paper surveys from 912 adolescents (42.9% males, 47.4% Hispanic/Latino). Peer influence was measured by a 15-item Likert scale with a Cronbach's alpha = 0.90. Parental monitoring was measured using an 8-item Likert scale with a Cronbach's alpha = 0.82. Media use scales were created for this study and summed participants' use (not at all, < 3 hours/day, 3-5 hours /day, > 5 hours/day) of various media (TV with or without cable, fashion or teen magazines, video games, computer with or without Internet, CD, VCR, or DVD player) by location (out-of-home; in-home, but not in room; in-room). Health-risk behaviors were measured using single items from the Youth Risk Behavior Surveillance Survey. Media use outside the home was statistically significantly related, inversely, to parental monitoring, and positively to drinking alcohol (p = .05), and number of sexual partners for females (p = .01); media use outside the home was also statistically significantly related to peer influence (p = .01); and marijuana use (p = .05) among females and males. Media use inside the home (but not in one's room) was significantly related to number of sex partners for females only (p = .05), but none of the other variables were significantly related for either females or males. Media use in one's room was significantly related to peer influence, smoking marijuana, drinking alcohol, and number of sex partners for females; it was also significantly related to contraceptive use for both females and males (p = .05). Among males, in-room media use was significantly inversely related to parental monitoring (r = - .12, p = .05). To our knowledge, this is the first study to explore the location of media use among adolescents and it suggests avenues for intervention that may be gender-specific. It also supports previous studies that indicate peer influence as a risk factor and parental monitoring as a protective resource for adolescents' health-risk behaviors. This approach to studying media, by location rather than technology, could be a model for future longitudinal studies where the evolution of media provides substantial measurement challenges.

Dental utilization of active duty/previous active duty US military: a cross-sectional analysis of the 2010 Behavior and Risk Surveillance Survey.

IntroductionThe purpose of this study is to understand dental utilization of 1) individuals serving/having served in active duty in the U.S. military as compared with the general public and 2) individuals who are currently serving as compared with individuals who are no longer active duty, but have been in active duty within the previous year.MethodsThe Behavior and Risk Surveillance Survey, 2010, was used in cross-sectional analyses to determine the comparisons. Chi square and multivariable logistic regression analyses were applied.Results70.7% of participants who had served/currently serving had a dental visit within the previous 12 months; 69.9% of the general public reported a dental visit (p = 0.0265). 69.8% of participants who had served/currently serving had a dental hygiene visit within the previous 12 months and 68.1% of the general public reported a dental hygiene visit (p <0.0001). The adjusted odds ratio (AOR) for participants who had served/currently serving vs. the general public was 1.10 (95% Confidence Interval [CI] 1.05, 1.16; p<0.0001) for dental visits and 1.11 (95%CI 1.05, 1.17; p<0.0001) for dental hygiene visits.ConclusionParticipants who are serving or have served were more likely to have any dental visit and dental hygiene visit than the general public; but the results were not substantively important.

Knowledge, Opinions and attitudes towards HIV and AIDS among Youth in Botswana

Knowledge, opinions and attitudes of youth towards HIV/AIDS are very important for HIV/AIDS prevention, care and support. Botswana is one of the countries in sub Saharan Africa which has long struggled with HIV/ AIDS epidemic and several program efforts aimed at enhancing knowledge about HIV/AIDS have been developed and implemented. The current paper utilizes data derived from Botswana Youth Risk Behavior Surveillance survey conducted in Botswana in 2009 which is a nationally representative survey of school going leaner’s aged 10 to 19 years. The main objective of the survey was to assess and monitor the prevalence of key youth health risk Behaviors and related risk factors in a random sample of learners aged 10 to 19 years, in 15 Ministry of Education and Skills Development (MoESD) districts of Botswana. Both bivariate and multivariate analyses were used to analyze data in SPSS version 21 program and results were presented as odds ratios and percentages. Bivariate analyses results indicate that 10.5% of students reported that HIV transmission cannot be prevented, 13.6% thought it can be prevented by not having sex if you suspect the person has HIV/AIDS, 5.8% thought that by having only a few partners at a time would prevent transmission of HIV, 11.3% were of the view that serial monogamy would help prevent transmission, and use of condom when one feels it is important to do so score highest with 14.0%. Multivariate analyses show that young children aged 10-13(OR=0.689) who are at primary school level (OR=0.235) are less likely to have correct knowledge about the relationship between HIV and AIDS and also about HIV transmission and prevention than their older counterparts. Females were more likely to show negative attitudes towards PLWA than males (OR=1.3).

Protective School Climates and Reduced Risk for Suicide Ideation in Sexual Minority Youths

We examined whether sexual minority students living in states and cities with more protective school climates were at lower risk of suicidal thoughts, plans, and attempts. Data on sexual orientation and past-year suicidal thoughts, plans, and attempts were from the pooled 2005 and 2007 Youth Risk Behavior Surveillance Surveys from 8 states and cities. We derived data on school climates that protected sexual minority students (e.g., percentage of schools with safe spaces and Gay-Straight Alliances) from the 2010 School Health Profile Survey, compiled by the Centers for Disease Control and Prevention. Lesbian, gay, and bisexual students living in states and cities with more protective school climates reported fewer past-year suicidal thoughts than those living in states and cities with less protective climates (lesbians and gays: odds ratio [OR] = 0.68; 95% confidence interval [CI] = 0.47, 0.99; bisexuals: OR = 0.81; 95% CI = 0.66, 0.99). Results were robust to adjustment for potential state-level confounders. Sexual orientation disparities in suicidal thoughts were nearly eliminated in states and cities with the most protective school climates. School climates that protect sexual minority students may reduce their risk of suicidal thoughts.

Location-based HIV behavioural surveillance among MSM in Auckland, New Zealand 2002–2011: condom use stable and more HIV testing

ObjectivesOver the last decade, annual HIV diagnoses among men who have sex with men (MSM) in New Zealand increased, then stabilised in 2006 and have not increased further. The aim...